RHEUMATOID ARTHRITIS

 CAPLAN SYNDROME: characterized by co

existence of sero + RA and rounded fibrotic
nodules in lung alongwith coal worker
pneumoconiosis
 FELTY SYNDROME: triad RA ,
SPLENOMEGLY, NEUTROPENIA
 DIAGNOSIS: ACR Classification
1. Morning stiffness
2. Arthritis of 3 jt areas
3. Arthritis of hands
4. Symmertric arthritis
5. Serum RF +ve
6. Rheumatoid nodules
7. Radiological changes
 ACR/EUROPEAN LEAGUE AGAINST
RHEUMATISM: present criteria fr diagnosis
INVESTIGATIONS:
1) GENERAL MEASURES: there is no cure for
RA
The goal of therapy is to maintain remission.
Bed rest nd splinting during acute stage.
Physiotherapy : helps in mobilization nd
prevention of contractures
2)MEDICAL THERAPY : - NSAIDS
- GLUCOCORTICOIDS
- DMARD’S
NSAIDS: symptomatic relief
- Don’t alter underlying ds. Process.
Therefore not used w/o DMARDS
- chronic use minimized d/t side effects
like gastric/peptic ulcer ds
GLUCOCORTICOIDS : Cause dramatic and
rapid improvement
- Not only symptomatic relief but also improve
radiological progression of RA
- PREDNISOLONE m/c used
- BRIDGE THERAPY: GLUCOCORTICODS
ARE FIRST USED TO SHUT OFF
INFLAMMATION AND THEN TAPER
OFF AS DMARD IS TAKING EFFECT.
- PULSE THERAPY: remission is induced
with I/M METHYLPREDNISOLONE IF
SYNOVITIS persists beyond 6 wks.
INTRAARTICULAR GC to reduce
synovitis.
DMARDS : ability to inhibit disease progress to
change disabling potential of RA
- Able to slow / prevent radiological
progression of RA
- CONVENTIONAL DMARDS(8) Exert
delayed onset action nd take 2-6 months to
exert full effect
- MTX(dmard of choice and anchor for most
combination)
- SULFASALAZINE
- HYDROXYCQ
- LEFLUNOMIDE
 - AZATHIOPRINE
- GOLD
- MINOCYCLINE.
- D-PENICILLAMINE
BIOLOGICAL DMARDS : used alongwith
MTX/ other conventional dmard
- Disadv:- high cost
- Long term toxicities
- Demyelinating syndromes
TNF-a Blockers: ETANERCEPT
- INFLIXIMAB
- ADALIMUMAB
IL-1 RECEPTOE BLOCKER: ANAKINRA
ANTI-CD20 ANTIBODIES: RITUXIMAB
T CELL AGENT:- ABATACEPT
TOFACITINIB

IMMUNOSUPPRESANTS: .CYCLOPHOSPHA
MIDE
.AZATHIOPRINE
SURGERY: IMPROVE PAIN ND
DISABILITY
. SYNOVOECTOMY
. OSTEOTOMY
. ARHTHODOSIS to relieve pain in atlantoaxial
jt,wrists,ankle
. EXCISION ARHTROPLASTY